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Big Data Impacting Healthcare

Posted on July 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Sarah E. Fletcher, BS, BSN, RN-BC, MedSys Group Consultant.
Sarah Fletcher
It is generally agreed that bigger is better.  When it comes to data, big data can be a challenge as well as a boon for healthcare.  As Meaningful Use drives electronic documentation and technologies grow to support it, big data is a reality that has to be managed to be meaningful.

Medical databases are becoming petabytes of data from any number of sources covering every aspect of a patient’s stay.  Hospitals can capture every medication, band-aid, or vital sign.  Image studies and reports are stored in imaging systems next to scanned documents and EKGs.

Each medication transaction includes drug, dose, and route details, which are sent to the dispensing cabinet.  The patient and medication can be scanned at the bedside and documentation added in real time.  Each step of the way is logged with a time stamp including provider entry, pharmacist verification, and nurse administration.  One dose of medication has dozens of individual datum.

All of this data is captured for each medication dose administered in a hospital, which can be tens of thousands of doses per month. Translate the extent of data captured to every patient transfer, surgery, or bandage, and the scope of the big data becomes clearer.

With the future of Health Information Exchanges (HIEs), hospitals will have access not just to their own patient data, but everyone else’s data as well.  Personal health records (PHRs), maintained by the patients themselves, may also lend themselves to big data and provide every mile run, blood pressure or weight measured at home, and each medication taken.

One of the primary challenges with big data is that the clinicians who use the data do not speak the same language as the programmers who design the system and analyze the data.  Determining how much data should be displayed in what format should be a partnership between the clinical and the technical teams to ensure the clinical relevance of the data is maximized to improve patient outcomes.  Big data is a relatively new event and data analysts able to manage these vast amounts of data are in short supply, especially those who can understand clinical data needs.

Especially challenging is the mapping of data across disparate systems.  Much of the data are pooled into backend tables with little to no structure.  There are many different nomenclatures and databases used for diagnoses, terminology, and medications.  Ensuring that discrete data points pulled from multiple sources match in a meaningful way when the patient data are linked together is a programmatic challenge.

Now that clinicians have the last thousand pulse measurements for a group of patients, what does one do with that?  Dashboards are useful for recent patient data, but how quickly it populates is critical for patient care. The rendering of this data requires stable wireless with significant bandwidth, processing power, and storage, all of which come with a cost, especially when privacy regulations must be met.

Likely the biggest challenge of all, and one often overlooked, is the human factor.  The average clinician does not know about technology; they know about patients.  The computer or barcode scanner is a tool to them just like an IV pump, glucometer, or chemistry analyzer.  If it does not work well for them consistently, in a timely and intuitive fashion, they will find ways around the system in order to care for their patients, not caring that it may compromise the data captured in the system.

Most people would point out that the last thousand measurements of anything is overkill for patient care, even if it were graphed to show a visual trend. There are some direct benefits of big data for the average clinician, such as being able to compare every recent vital sign, medication administration, and lab result on the fly.  That said, most of the benefit is indirect via health systems and health outcomes improvements.

The traditional paper method of auditing was to pull a certain number of random charts, often a small fraction of one percent of patient visits.  This gives an idea of whether certain data elements are being collected consistently, documentation completed, and quality goals met.  With big data and proper analytics, the ability exists to audit every single patient chart at any time.

The quality department may have reports and trending graphics to ensure their measures were met, not just for a percentage of a population, but each and every patient visit for as long as the data is stored.  This can be done by age, gender, level of care, and even by eye color, if that data is captured and the reports exist to pull it.

Researchers can use this data mining technique to develop new evidence to guide future care.  By reviewing the patients with the best outcomes in a particular group, correlations can be drawn, evaluated, and tested based on the data of a million patients.  Positive interventions discovered this way today can be turned into evidence-based practice tomorrow.

The sheer scope of big data is its own challenge, but the benefits have the potential to change healthcare in ways that have yet to be considered.  Big data comes from technology, but Meaningful Use is not about implementing technology.  It is about leveraging technology in a meaningful way to improve the care and outcomes of our patients.  This is why managing big data is so critical to the future of healthcare.

MedSys Group Consultant, Sarah E. Fletcher, BS, BSN, RN-BC has worked in technology for over fifteen years.  The last seven years have been within the nursing profession, beginning in critical care and transitioning quickly to Nursing Informatics.  She is a certified Nurse Informaticist and manages a regular Informatics Certification series for students seeking ANCC certification in Nursing Informatics.  Sarah currently works with MedSys Group Consulting supporting a multi-hospital system.

The Week of the EMR Celebrity

Posted on July 18, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

What a strange week in healthcare IT it’s been, particularly where EMRs are concerned. First came breaking news that Kim Kardashian’s privacy potentially had been breached (insert ironic arch of eyebrow) by Cedars-Sinai employees who had inappropriately accessed patients’ private medical records last month. Then came much more noble press via NPR, which has devoted a series on All Things Considered this week to profiling the world of EMRs:

I had to shush my husband – clap a hand over his mouth, actually – when the NPR interview with Farzad Mostashari came on. “I’ve met that guy!” I told my husband. “He’s a celebrity in our industry, but for all the right reasons!” It was almost invigorating, especially after reading Kardashian headlines, to hear him discuss the many points we’ve all been debating and/or covering for the last few years. He was just as much a compelling cheerleader for the adoption of EMRs and the impact they are likely to have on patient safety as he had been when he bounded across the stage at HIMSS a few years ago.

Which brings us to the middle of the week, when CMS released its latest set of data touting the latest round of EMR success:

  • More than 50% of eligible health care professionals and 80% of eligible hospitals have begun using electronic health record systems since the meaningful use program launched in 2011
  • Shared more than 4.6 million EHR copies with patients;
  • Sent more than 13 million appointment, test and check-up reminders;
  • Checked medication interactions more than 40 million times; and
  • Sent more than 190 million electronic prescriptions

I’m beginning to think that CMS and federal agencies like the ONC are really getting the hang of this media game. I’m sure it’s no coincidence that NPR ran its stories the same week CMS released its latest success story. I just wonder how the general public is digesting this information. With 80% of hospitals now on EMRs, it’s a safe bet that the majority of patients in this country (even Kim Kardashian) have information stored away in one. Are they beginning to realize the benefits this technology brings to their care? Or are most patients still uneasy with the lack of eye contact from their doctors, who are now glued to a computer screen?

Do the CMS numbers tell the whole truth? Has patient safety increased to the detriment of patient satisfaction with bedside manner? Let me know your thoughts in the comments below.

California Nurses Slam Sutter’s Epic System

Posted on July 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Nurses at two Sutter hospitals have flooded the management with complaints that the Epic EMR installed there is causing safety problems and eating up time best spent in patient care.

According to a statement from the California Nurses Association, more than 100 RNs at Alta Bates Summit Medical Center facilities in Oakland and Berkeley have filed reports citing problems with the new Epic system in place there.  The nurses submitted these complaints on union forms designed to document assignments the nurses believe to be unsafe.

Specific incidents documented by the nurses included the following. (Apologies for the length of the list, but it’s worth seeing.)

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

This is not the first time nurses have gone on the warpath over issues with their hospital’s EMR rollout. Just last month, RNs at Affinity Medical Center in Massillon, OH got national attention when they cited problems in training and safety with the Cerner rollout in progress there.

Taken on their own, I don’t think such protests are going to much to slow the progress of EMR rollouts nationwide, even if the nurses involved are spot on in their observations.  Once the EMR juggernaut starts rolling, it’s very, very hard to slow it down.

But with any luck, the complaints will draw the eyes of regulators and patients to EMR safety and training concerns, and that will lead to some form of change. The issues raised by the Sutter RNs and others shouldn’t (and can’t) be pushed aside indefinitely.

HIMSS Health IT Value Suite Thoughts and Infographic

Posted on July 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, HIMSS made an announcement of the HIMSS Health IT Value Suite. In its essence, HIMSS has collected a series of health IT use cases and good experiences that healthcare has experienced using health IT.

The HIMSS Health IT Value Suite has more than 500 cases demonstrating 56 different health IT benefits. That’s a good number of use cases and experiences. One of the most compelling parts of this is the first hand quotes by doctors about the benefits they have seen using health IT. There’s little more powerful to a doctor than another doctor’s testimonial.

The challenge I have with the HIMSS Health IT Value Suite is that most doctors already look at HIMSS as the Healthcare IT cheerleaders as opposed to an unbiased source of health IT information. In fact, while doctors love to hear from their peers, that peer recommendation will likely be reduced if it’s coming from a HIMSS product offering.

I think it’s unfortunate that the HIMSS Health IT Value Suite didn’t include the negative health IT use cases as well as the good ones. By only including the positive ones, they diminish the credibility of the suite. It’s almost as if they act like health IT couldn’t have negative impacts. Doctors know better and will discount any source that doesn’t provide the full view of the impacts of health IT.

To make the HIMSS Health IT Value suite even better, they should share both the benefits and risks of health IT. A lot can be learned by seeing use cases where health IT didn’t benefit a clinic. Those health IT failures can be used to teach how not to do health IT and what could be done differently to avoid those negative results.

I do find interesting the infographic that HIMSS put out about the STEPS (Satisfaction, Treatment/Clinical, Electronic Information/Data, Prevention/Patient Education, Savings) definitions they created to classify the benefits of health IT. You can see it by clicking the image below.
HIMSS Health IT Value Suite Infographic

What do you think of the HIMSS Health IT Value Suite?

Ideas, Insights and Predictions from Healthcare Social Media Thought Leaders

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought it would be fun to experiment with a new type of blog post. I came up with the idea during the recent #HITsm chat. I decided I’d ask 5 of the #HITsm participants to share an idea, prediction, insight, or thought that I could share in a blog post. I didn’t give them a topic, direction, or ask any questions. I just asked them to share something that thought would be useful or interesting. I found the results quite interesting.

I asked 5 people to tweet something. Only 4 of the 5 responded (probably a lost Twitter DM), but one of the people sent two tweets. So, the following are the 5 tweets with a little bit of commentary from me.


This is a really interesting insight. Chad has a really good point. I’m not sure I’ve seen a truly open HIE that just wanted to be the company sharing the data. I think a few have that goal in mind, but they haven’t gotten there yet. It will be a real game changer when an HIE just wants to be the pipes and not the faucet as well. I will say that most healthcare organizations aren’t quite ready to implement the faucet though either.


Thank you Dr. Nan for bringing some humor to the post. I love it! Although, maybe it’s not that funny since it rings far too close to the truth. I might also share this with my wife so she understands age appropriate behavior for our children.


This was the other tweet that Dr. Nan sent. You can tell it comes from a raw place. I’m actually surprised we don’t talk about doctor depression more. I read a lot of entrepreneur blogs and there’s been a real increase in discussion around entrepreneur depression. I expect that doctors could really benefit from this discussion as well. For some reason there’s a fear of discussing the real challenges and pressures of the job.


Would we expect anything other than workflow from Dr. Webster? I’m not sure I like his prediction. I hope he’s wrong. I don’t want a workaround for EHR workflow. I want something drastically different.


I love this concept and refer to it as treating healthy patients. Although, I love Ryan’s approach of patients taking responsibility for their own health and engaging with those they love in health-generating behaviors. Sure, doctors are miracle workers, but we as patients should be much more involved in our health as well.

That’s all she wrote. If you like this idea, let me know. If you’d like to participate in a future post, be sure to tweet me @ehrandhit.

Epic Investment May Have Prompted CIO’s Departure

Posted on July 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As Forbes notes, Epic Systems has a gold-plated reputation in the hospital C-suite. In fact, we’re at the point where it’s accepted wisdom that you can’t lose your job for picking Epic.

But this time, it may actually have happened.  Barry Blumenfeld, former chief information officer at Maine Medical Center in Portland, seems to  have ended up leaving in part because of the financial impact of the hospital’s $160 million Epic buy, Forbes reports.

It’s worth noting that Maine Medical Center had other financial problems in addition to the cost of the Epic implementation. It’s also important to bear in mind that the Epic install seems to have gone badly, slowing collections and thereby cutting revenue. But the fact remains that the big-ticket Epic purchase wasn’t a golden ticket for Blumenfeld.

According to Forbes, other stories of career-mangling Epic disasters are popping up as well. For example, it noted that the chief information officer of Wake Forest Baptist Health recently resigned in the middle of a troubled Epic launch.

Sheila Sanders, who was also VP of information technology, had been on board since 2009, hired to direct the facility’s IT overhaul, according to the Winston-Salem Journal. The Journal piece notes that Wake Forest, too, has seen expected revenue delayed due to problems with the Epic rollout. The hospital had spent about $13.3 milion on Epic, and now cites $8 million in Epic-related implementation expense and $26.6 million in lost margin due to volume disruptions related to go-live issues.

Of course, a CIO can lose their job if any EMR they’re implementing calamitously fails to live up to expectations, be it Epic or another platform. But these anecdotes suggest that the high expense associated with an Epic rollout — and perhaps just as importantly, high expectations — can do more to damage a CIO’s reputation than some might think.

Healthcare vs Sickcare, MU Undermines EHR Usability, and Kaiser Monkey Game

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This might seem a little self serving since I sent this tweet in reply to Georg Margelis’ comment. It’s a really good question though and one I’ve been starting to think about recently. I’ve often heard that the really sick people are the ones that cost healthcare so much money. My question is whether keeping them healthy just delays the costs or whether keeping them healthy actually costs less money long term.


This is such an important topic. I’ve been commenting more and more on this subject. I’ve wondered if a usable EHR can be created that satisfies MU. I imagine it depends on how you define usable.


This is a pretty cool Monkey game from Kaiser. Although, the real value in this article is better understanding some of the approaches that Kaiser is taking to healthcare. So many people salivate over working with Kaiser. It’s good to understand what they are and aren’t looking for if you’re looking for that relationship.

Healthcare Cost Transparency: Let the Revolution Begin

Posted on July 12, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’m a big fan of historical fiction, and just finished up “Madame Tussaud: A Novel of the French Revolutionby Michelle Moran. I’ve read many fictional and non-fictional accounts of that time period, but the depiction of the French citizenry’s dissatisfaction with the monarchy and just about everything else in their society struck a particular chord with me this time around. I don’t think I go too far in saying there is just a hint of their discontent brewing in the world healthcare consumers. While consumers and patients haven’t quite reached the level of hysteria the likes of Robespierre or Marat did centuries ago, there now seems to be a societal voice given to a need – I’d go so far as to say a right – to know the true costs of medical services before and after they are supplied.

And I wonder if the government’s push towards electronic medical records and more coordinated care isn’t halfway to blame. Easily accessible information, such as patient health data and doctor’s notes that can now be placed directly in patients’ hands has made us all wonder, “If I can understand the reasoning behind my doctor’s directives, why can’t I understand the reasoning behind the cost of that care?”

I mentioned last week my discontent with the way I was approached by my hospital to pay for labor and delivery services shortly after my daughter’s birth. It was no surprise to me then to come across “American Way of Birth, Costliest in the World,” a well-written article in the New York Times chronicling a number of mothers’ similar frustrations with healthcare costs, billing and payment. In these days and times, I could not imagine trying to navigate the financial part of pregnancy, labor and delivery without insurance coverage. And it saddens me that for all the money that we spend in this area of healthcare, our infant and maternal mortality rates are nothing to be proud of.

But I digress. My true point this week is that there is a growing movement by consumers to demand transparency into healthcare costs – ideally before treatment is given, but most definitely after it is received. Providers should be able to explain services line item by line item, and consumers should be able to compare the costs of those services provider by provider, hospital by hospital. I’m confident we’ll get there, as this movement only seems to be growing. There’s an interesting timeline that has occurred:

March 4 – Time Magazine publishes Steven Brill’s oft-referenced article “Bitter Pill: Why Medical Bills are Killing Us,” perhaps kicking off CMS’ attempts to bring greater transparency to healthcare costs

May 7 – CMS releases new open dataset to shed light on hospital pricing variations

May 8 – Mainstream press, such as The Washington Post, publish lengthy online articles complete with data visualizations to assist consumers in understanding the vast differences between what hospitals charge Medicare for their services.

May 15 – CMS releases state and national averages a week after The Washington Post article, aggregating the data for comparison on the state level.

June 3 – CMS releases another wave of data, including average estimated submitted charges for 30 types of hospital outpatient procedures; information on Medicare spending and utilization at the county, state and hospital-referral region; and the prevalence of certain chronic conditions among Medicare beneficiaries.

July 5 – The Center for Studying Health System Change releases study on “Geographic Variations in the Cost of Treating Condition-Specific Episodes of Care among Medicare Patients” showing that geographic variations in Medicare medical treatment costs can differ among episodes of care for certain conditions and not only across but within regions.

How will all this play out in the coming years? Will consumers continue and increasingly demand to know what healthcare will cost them? Will private payers offer up this same type of information sooner rather than later? Should this knowledge be a right, rather than a privilege? What do you think? Let me know via the comments section below.

New Certified Health IT Mark from ONC

Posted on July 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the keys to a good certification is good branding. Think about JD Power and Associates. When you see that brand, you know what it means and what it represents. For EHR software, ONC is likely hoping that their new ONC Certified HIT mark will do something similar for EHR software.

Here’s the mark you should look for to know if an EHR meets the 2014 Edition Standards and Certification criteria:
ONC EHR Certification - Health IT Mark

What’s in a mark? I think it currently serves two purposes. First, it says if that EHR vendor can help you show meaningful use and get the EHR incentive money. This is the most important part of a good mark. The second is that EHR vendors that have this mark will have conformed to the interoperability standards that are set in the EHR certification process. I’m hopeful that this is the most valuable thing that comes out of EHR certification and meaningful use.

The following is the full press release from HHS about the new EHR certification mark.

EHR products must meet standards and certification criteria to be certified

A new mark for certified electronic health records (EHR) technology was unveiled today by the HHS Office of the National Coordinator for Health Information Technology (ONC). The mark will appear on EHR products that have been certified by an ONC-Authorized Certification Body (ONC-ACB) and will indicate that the product meets the 2014 Edition Standards and Certification Criteria.

Eligible professionals and hospitals must demonstrate meaningful use of EHR technology that has been certified under the ONC Health Information Technology (HIT) Certification Program to qualify for Medicare and Medicaid EHR incentive payments.

“We’ve reached the tipping point of doctors adopting electronic health record systems and using them to improve patient care,” said Farzad Mostashari, M.D., national coordinator for health information technology. “The use of the ONC Certified HIT mark will help to assure them that the EHR they have purchased will support them in meeting the Meaningful Use requirements.”

Electronic health records technology may be certified by one of four ONC-ACBs accredited by the American National Standards Institute (ANSI) and authorized by ONC. The mark is a visual cue that the product – whether a complete EHR, an EHR module or another type of health IT product – meets ONC’s applicable certification criteria and can achieve interoperability, functionality and security. For example, the criteria include such requirements as computerized provider order entry (CPOE), drug to drug and drug-allergy checks, and the capability to coordinate clinical information to help improve the quality of patient care, among others.

When the mark is associated with a certified “Complete EHR” it means that the EHR technology can be used without modification to achieve Meaningful Use. A certified EHR module may be combined with other modules to make a complete system. Some modules may include the ability to:

  • ·         Create a standard patient summary care record;
  • ·         Securely transmit summary care records using Direct, a tool created through an ONC-led collaboration with broad health IT industry participation, that allows for the secure exchange of health information over the Internet; and
  • ·         Provide patients with online access to view, download, and transmit their health information to destinations of their choice.

ONC-ACBs will begin to issue the mark to certified EHR products immediately. To learn more about the terms and use of the mark, click here.

Providers In Underserved Areas Lagging On EMR Implementation

Posted on I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Providers in large metros are less likely to have implemented EMRs than those in smaller metro areas and rural areas, according to a study written up by Healthcare Informatics.

The study, which appeared in Health Services Research, set out to determine whether EMR adoption was lower in traditionally underserved areas. To look at this issue, in 2011 researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers, covering 50 states and the District of Columbia. Provider sites ranged from one-physician practices to large multi-physician groups, Healthcare Informatics reports.

Researchers found that areas with high concentrations of minority and low income populations, as well as those in large metropolitan areas were more likely to be in the lowest quartile of EMR adoption nationally, as compared with rural areas. The study also found that 43 percent of providers working in ambulatory healthcare sites had EMRs with e-prescribing capabilities, Healthcare Informatics reports.

Clearly, if researchers were expecting to find a lack of EMR adoption in these metro practices, they hit the nail on the head. I’d like to know, however, why things fell out this way.

Are metro practices lacking the resources to adopt EMRs in a more pronounced way than rural practices? Is there some phenomenon in the works in which underserved populations aren’t expecting EMRs, and therefore aren’t pressuring providers to implement them?

It’s worth noting that according to HIMSS data for Q1 2013, about 50 percent of ambulatory providers were still paper-based, and that nearly half of remaining practices were still stuck at Level 3 of adoption (CDR, access to results from outside facilities) or lower.

I’d argue that the gap between practices with mature implementations and those who are barely crawling is of equal importance and worth a study of its own. In the meantime, it is worth considering what can be done — beyond Meaningful Use incentives, clearly, or the gap wouldn’t exist — to be sure that EMR uptake doesn’t hit a snag with metro providers.